The Pre-Menopause Chronicles: Navigate Perimenopause with Your Medical Yoda and a New Hope
Don't believe that you need to deal with symptoms because they are "what happens when women get old." Navigate perimenopause like Leah navigated managing the rebellion in A New Hope.
We all have a picture in our minds of women in that “change of life.” Often, it is of women we saw getting hot flashes or discussing how uncomfortable they were. Some of us might be in that part of life, or are close enough to think about it off and on. But the question is: What do we want this time frame in OUR lives to look like? And what tools should we have in order to make this time frame in our lives better than what we picture?
The change of life timeframe when most women experience the symptoms we often associate with menopause is actually called perimenopause. Perimenopause is when the baby factory starts to shut down for business but is still open for those “change of life babies” like my baby brother David. David, I still love you even though you were raised like an only child and got all the stuff your other siblings never got as kids, like name-brand breakfast cereal.
Menopause: no menstrual cycle for one full year
Perimenopause: 40 ish-50 ish. Hormone testing will confirm if you are in perimenopause or not.
Perimenopause occurs at a time in our lives when we have some extra stuff in our schedules that was not there in our twenties. We probably have significant others, jobs that require more sitting and less movement, kids, mortgages, and cars that require regularly scheduled maintenance. Keeping all the lists together is a pain, and it is tempting to leave yourself off of that list because life is already complicated enough.
Here's a recent personal example where I endured a situation that allowed the discomfort to affect my life week by week. It was not a huge impact so I just let it go because I could still generally get everything done. It just took longer.
I had this fuzzy microfleece sheet on my daughter’s bed as of last week. It is the bane of my laundry day. It spreads its fuzzy everywhere. I don’t wash it or dry it with anything else, yet it manages to spread its fuzz to other clothes, mostly all of my black clothes which is just great. Occasionally, my husband has dried it with an entire load of the kids' clothes, which means an hour of using a lint roller to remove all the fuzz that got all over their school uniform. This has been going on for months. Just last week, I decided it was worth the money to get a new sheet set and throw the other ones away.
Hot flashes and urinary incontinence are going to affect you more than fuzz on all the shirts in your laundry, but just like the fuzz, you can deal with it. You can make the best of it. However, the time you spend dealing with symptoms that cause discomfort throughout your day adds up slowly and steadily.
Don’t wait to take time for yourself. Don’t let symptoms be the bane of your existence like that sheet was for me each week. Sheet day takes less time now than it did before. I can wash bigger loads and get them done earlier. When you are less uncomfortable, you will be able to do more with your day and feel better while doing it.
Talk to A Menopause Yoda You Should
We live in a world where:
People with severe spinal cord injuries who two decades ago would have lived the rest of their life in a wheelchair can now walk again with therapy.
Several types of heart operations are done with small cameras and instruments inserted into arteries in the arm.
HIV and Hepatitis C have been cured.
Yet we also live in a world where:
Women often deal with their “lady part issues” for long enough that they have pee pads on their regular shopping lists. 100% treatable with strengthening and/or estrogen cream depending on your body. If you want help with pelvic floor strengthening, check out this link.
Women don’t want to be intimate because of hormonal changes affecting dryness. 100% treatable with estrogen cream and other options.
No woman (or man for that matter) would wait 10 years if they couldn’t reach their hand as high as their shoulder. Your lady parts and symptoms affecting your daily life deserve the same type of care. So, how do you go about finding a medical provider?
Don’t Settle for a Menopause Wookie. Keep Searching for Yoda
You may or may not have a regular healthcare provider, such as a doctor or a nurse practitioner. If you don’t, please ask around your local area for recommendations because a lot of this information needs to be discussed with someone who can look at your past medical history and what you are currently dealing with on a day-to-day basis.
Here is the problem.
Even if you have a provider, research shows you are not likely to talk to them about your hot flashes or vaginal dryness symptoms. It can be an uncomfortable conversation. It is also possible that the current provider said something to the effect that your “woman issues” are just a part of aging.
If your provider has said or ever says such words to you, it reflects medical incompetence in their ability to treat women’s health. Women shouldn't simply tolerate issues like urinary incontinence, discomfort in their lady parts during intimacy, or hot flashes for years and years when treatment is available.
Women’s health is essential. Don’t buy into the unjust statement that “this is what happens when you get old.” You are important enough to see someone who understands this time frame of life, has received training on it, and can guide you through the options.
Will the Real Menopause Specialists Please Stand Up, Please Stand Up
Okay, ladies. Here is a quick note on practitioners in medicine.
Please, for the love of chocolate, fuzzy kittens, and huckleberry pie, do not assume that just because ONE specialist was not helpful, all specialists are not helpful.
I have such a hard time when my patients say they tried their OBGYN or their primary care provider once. They weren’t helpful, so they are going to get their hormones tested by their chiropractor or massage therapist or whatever random profession you want to throw in there that had exactly ZERO training and board testing on hormone changes in perimenopause and menopause. They don't know what they're doing any more than koalas know how to perform a ballet.
Do I hate chiropractors or massage therapists and think they are bad people? NO!!!!! I think that if you want to get an adjustment from a chiropractor, you should. I think this because they actually got their training on GIVING ADJUSTMENTS. They took board certification tests on GIVING ADJUSTMENTS. Chiropractors and massage therapists got exactly as much training as I did on hormone replacement and testing for hormone levels, which is to say none.
Doctors and nurse practitioners go to school for years and are tested at school and then by a national board to ensure they know enough to talk to a patient about their medical history and hormones. They understand that hormones fluctuate throughout the month and even within a single day. They understand that hormone level testing should be conducted consistently on the same day of your menstrual cycle. Additionally, a doctor or nurse practitioner may want to compare your levels from one month to the next, such as testing on day 5 this month and day 5 next month.
It's crucial to consult with a professional who is trained to conduct these tests and skilled in interpreting the results in the context of your menstrual cycle and medical history. So, how do you go about finding such a qualified individual?
Who Should Be Your Perimenopause Yoda?
You can pick who you see, so revel in this choice, dear reader.
Unlike most of her generation, who viewed their doctor’s word as law, my grandma was pretty outspoken with her doctor if she felt like she wasn’t getting the care she needed. She also said you can say whatever you want after age 80, but you should start practicing earlier to make sure you get it right.
Sadly, Grandma never got to see someone who was trained to help her navigate perimenopause and menopause due to living in rural Montana.
Finding your medical Yoda might require a drive.
The truth is that seeing someone who specializes in helping you navigate the symptoms of perimenopause and menopause will probably require a drive or maybe even a flight. The perimenopause years of your life should not be spent living with symptoms that can be treated. By all means, see a provider near you, but if you don’t find the answers you are seeking, you might need to travel to Dagobah* or just a different city.
*where Luke Skywalker went to train with Yoda. Yoda and baby Yoda can’t help with hot flashes, so look closer to home and stick with planet Earth when looking for a provider.
Medical providers can join specific organizations if they are interested in treating patients navigating the perimenopause and menopause phases of life. If you aren’t satisfied with your doctor’s answers to your questions about your symptoms, you should look into these specialists.
List of International Country Menopause Societies (may or not have links to providers depending on country)
Middle East Menopause Facebook Group (based in the United Arab Emirates but includes recommendations for practitioners in other Middle Eastern countries)
Hope and Empowerment When Your World Strikes Back
We need to shift our perspective to hope instead of dread or passive acceptance of the common story of the perimenopause and menopause time frame. The work of researcher C.R. Synder shows that hope is not factory-installed at birth but a skill that can be cultivated in the mind. According to Snyder, hope is believing you can find ways to reach your goals and pursue them until they become a reality.
The brain naturally aims for goals. When you set a goal, it creates a kind of tension in your brain. This tension comes from hope and drives your brain to focus on the gap between where you are and where you want to be and between who you are now and who you want to become.
This same tension from goals can lead to cognitive dissonance in midlife, which is the uncomfortable feeling of trying to reconcile two conflicting beliefs.
For example:
You might struggle with thinking that you need to slow down and ask for help while believing that other moms are making it work without help, so you should be able to make it work as well.
OR
(Me Five Years Ago) I need help, but it is going to be too much work to get someone who can do it the right way, so it is best to do it myself (this included help from my husband). All of this effort is put into doing it myself instead of doing something FOR myself like exercising, resting, meeting with your community/power posse, and planning so you can eat well.
All of us by perimenopause have had a hope (goal) go wrong in the past. A hope that was painful to lose and resulted in a different undesired chapter being written. There is fear when we are faced with the prospect of hoping again for ourselves. This is because we feel and remember the sadness of losses more than we feel the joy of winning. It’s science.
The scars from past defeats can make the prospect of pursuing our own goals again seem daunting, especially when we are no longer 20. Work goals? Sure. Goals for the kids? Absolutely. Goals for me? Crickets.
The Force that Fuels Perimenopause Change
If you are a woman, you are familiar with the scenes that play in your mind, typically as you lie in bed. You know, those scenes where you relive various bad decisions you have made since you were 13 years old.
We need to take this ability and convert it. Put your ability to review mistakes down and reverse it. Channel your inner Missy Elliott (she is 52, so she is DEFINITELY in the perimenopause/menopause time frame and still working it).
Setting goals and maintaining hope is all about our ability to Pre-play and prime our day before it starts.
“If you were to live this day over, what would you change?”
Viktor Frankl, a psychologist who survived Auschwitz, often encouraged his patients to consider this question as a way to start their day. It offers a remarkable way to begin your day. It changes the plot from only critically reviewing past events we cannot change to pre-playing a day where you make choices you want within your day-to-day life constraints.
Frankl was ahead of his time. He helped people use their imagination to write a story about how the day would go before it even started. He had them prime themselves for how their day could go if they avoided making choices they didn’t want to make.
Priming is a great way to mentally plan our days, weeks, and months (P.S. It is backed by TONS of research). This mental preparation makes us more inclined to take the necessary steps toward achieving our goals, even when managing household schedules, work schedules, and kids' activity schedules is complicated.
When we are primed for the day, we have a sense of purpose, challenges often seem more surmountable, and our resilience is bolstered. Will every day go as we pre-play? No. Nothing always works, but priming by pre-playing our day will give us an advantage about how the day will play out even with the unexpected events.
Pre-playing your day can transform how we navigate perimenopause, turning it from a period of “I’m too busy to do that for myself” into a time of opportunity and personal growth. With priming, we are tailoring our brain’s hope settings and turning up the brightness of that light at the end of the tunnel. Here’s the thing that all of this will require
To prime our days, we MUST spend some quiet time each morning to wake up to our own souls.
Your soul longs to write the story of your life and not let other life distractions write it for you.
To have this quiet time, we must stop letting our phones dictate how we start our days. We need to start our days without notification, email, and social media, which gets us jerked in the hurry and distraction of the day. To write our next chapter and become the kick-ass perimenopausal/menopausal woman we want, we must ruthlessly eliminate starting our day with distraction and hurry.
Reclaim your hope for perimenopause and pre-play your day. Prime your day and your week. Pre-play finding your perimenopausal Yoda and how great it will feel to find someone who understands and can help.
Perimenopause is not Your Father. It is not the Boss of You.
Ladies, if you want to live your life, live it all the way, and don’t waste those 10 years between perimenopause and menopause.
Rewrite the narrative of perimenopause and menopause. You can transform this phase into a period of a slow but steady positive transition by pre-playing your day.
Don’t let life get so busy with your day-to-day life to live emotionally and physically healthy lives. That is the kind of busy that will keep your story on repeat.
D.I.G. Deep Action Steps
Get Deliberate
I recorded a pre-play of my week, just one weekday at a time. Most Mondays are the same as last Monday, so I have a little pre-play of my Monday I will listen to in the morning. You can write it down, but I like listening because it helps me visualize the story of my day. I also include time at the end to think about what hard things this specific Monday will have. I then have time to pre-play scenarios where things go wrong, but I can still get my most important thing started, or I don’t need 60 minutes to work out and can do a quick 10-minute run.
Get Inspired
Think of someone who is in a similar life situation as yourself, but they are doing something well you want to start doing well in your day. Maybe you have three teenage boys, and they have three teenage boys. I guarantee their day doesn’t always go how they want, but ask them if something they do specifically helps them get x,y, or z done. Try to include some version of that in your pre-play or ask if you can meet up to help each other work on getting a super toned pelvic floor. #friendsdontletfriendspeetheirpants
Get Going
Write out your pre-play for tomorrow. Maybe even record it on your phone so you can listen to it. Pause notifications until later in the morning so you can start with your pre-play and not get distracted and hurry into your day.